Citation Nr: 18151849 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-30 915 DATE: November 20, 2018 ORDER Entitlement to service connection for a chronic left thumb strain/soft-tissue injury, is granted. FINDING OF FACT The residuals of left thumb sprain, currently identified as a chronic left strain/soft- tissue injury, is related to an in-service injury. CONCLUSION OF LAW The criteria for service connection for a chronic left thumb strain/soft-tissue injury have been met. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a veteran (the Veteran) who had active duty service from February 17, 2009 to February 14, 2013. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran provided testimony at a February 2017 videoconference hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is associated with the claims folder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The Veteran contends the residuals of her left thumb sprain are the result of an injury in service. The Board finds that the preponderance of the evidence supports the Veteran’s claim and it will be granted. An August 2012 service treatment record (STR) indicates the Veteran suffered a hyperextension injury to her left thumb. At the time of the injury the Veteran was in deployment training when she hit a pole resulting in her falling onto another pole and injuring her thumb. As a result of the injury, the Veteran was instructed to wear a supportive wrist and thumb spica and the use of her weapons, driving, and use of dangerous equipment was limited to assist in the healing process. A November 2012 service treatment record indicated the Veteran’s thumb pain was making significant progress and the Veteran had begun the weaning process from the thumb spica. In September 2013 the Veteran filed a claim for disability for the residuals of her left thumb sprain, left great toe fracture, and PTSD. The Veteran was afforded a VA examination in April 2014 in which the examiner, diagnosed the Veteran with hyperextension/strain and concluded it is less likely than not that any current left thumb condition is related to a hyperextension or strain from 2011. Instead, it is more likely than not related to normal age progression and deconditioning. Additionally, strains resolve in two to three weeks without sequelae. A May 2016 VA orthopedic clinical notes prepared by an attending physician notes the Veteran’s history of injuring his left thumb in service in 2012. There was stabbing pain over the metacarpophalangeal joint of the thumb with range of motion. The impression was “chronic soft-tissue injury of the MP thumb.” Upon review of the evidence of record, the Board finds that the evidence is at least in equipoise as to whether the residuals of the right thumb is related to the Veterans in service hyperextension strain. As an initial matter, the Board notes that the Veteran has a diagnosis of the left thumb, variously described as hyperextension/strain and chronic soft tissue injury. As such, the Veteran has met the current disability requirement for service connection. Further, STRs reflect a left thumb sprain injury in August 2012, which meets the second criteria for service connection for an in-service injury. While the April 2014 VA examiner provided a negative nexus opinion in regard to the Veteran’s diagnosis of hyperextension/strain, the Board finds the opinion inadequate because it is internally contradictory by stating that on the one hand, the Veteran’s symptoms are due to normal age progression and deconditioning, thus indicating a chronic condition; while on the other hand stating that strains resolve in two to three weeks without sequelae, indicating that the condition affecting the left thumb is acute and transitory. The May 2016 VA physician, while not overtly opining that there is a connection between the current thumb disability and the injury sustained in service, he did describe a chronic soft-tissue injury to the left thumb, in the context of the history of the documented in-service injury. No other intercurrent injury was described; indeed, the description of the left thumb injury as chronic implies that it is etiologically related to the documented in-service injury. The Board finds the May 2016 physicians opinion highly probative evidence of record as it is more recent, it was conducted by the Veterans regular attending physician, it’s based on the Veterans medical history, and includes a complete and continuous review of the file in coming to an opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The evidence is thus at least evenly balanced as to whether the Veteran’s currently diagnosed left thumb disability is caused by her in-service injury. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for hyperextension strain of the left thumb is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. [SIGNATURE ON NEXT PAGE] JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Jackman, Associate Counsel